National burden and geographic variation in healthcare utilization and expenditures among adults with heart failure in the United States (2013–2022)

Background Heart failure is a leading cardiovascular condition associated with substantial healthcare utilization and economic burden in the United States. However, less is known about regional and temporal variation in heart failure-related healthcare utilization and expenditures within nationally representative populations. Objectives To examine regional and temporal variation in healthcare utilization and expenditures associated with heart failure in the United States from 2013 to 2022. Methods Using inflation-adjusted data from the Medical Expenditure Panel Survey (2013–2022), we estimated incremental healthcare expenditures and utilization associated with heart failure. A two-part model was used to estimate total and service-specific expenditures, and a hurdle model was used to assess healthcare utilization. Models adjusted for sociodemographic and clinical characteristics. Results Individuals with heart failure had significantly higher annual healthcare expenditures compared with those without heart failure (5, 765 per person; 95% CI: 4, 015–7, 615), corresponding to approximately 6. 53 billion in national incremental costs. Adjusted per-person expenditures were highest in the Northeast (6, 120) and lowest in the South (5, 419), although the South contributed the greatest overall burden (2. 68 billion annually). Healthcare expenditures increased over time, particularly for outpatient and office-based services. Individuals with heart failure also had greater utilization of emergency department and outpatient services, with patterns varying by region. Conclusions Heart failure is associated with substantial and increasing healthcare utilization and expenditures in the United States, with important regional differences. These findings may inform heart failure management and care delivery strategies, particularly in strengthening outpatient and multidisciplinary care across regions.